Healthcare management system using patient profile data

Abstract

The present disclosure is directed to a system and method which gathers information from all of a person's healthcare providers and abstracts from that information the data necessary for a healthcare provider to render informed medical decisions. In one embodiment, information necessary to process proper payment to a provider (re: reimbursement to the insured patent) is used to develop a holistic view of the medical condition pertaining to the patient. Since this information comes from a myriad of providers, including physicians, surgeons, nursing care, druggists, testing labs, mental health counselors, dentists, oral surgeons, etc., the holistic view that is developed is comprehensive. In one embodiment, the system and method could set parameters on critical data such that if that data is outside the set parameters, alerts can be sent to the appropriate caregivers and/or patients.

1 . A method for providing a holistic view of a patient's medical condition, said method comprising: 
 abstracting information coming to a payor from medical providers, said information pertaining to a particular patient and coming from diverse locations and from diverse disciplines;    storing said abstracted information over a period of time on a patient-by-patient basis; and    upon a triggering event providing at least pertinent portions of said stored information to a medical provider, said pertinent portions based upon the totality of the information provided to said payor pertaining to a particular patient.    
     
     
         2 . The method of  claim 1  wherein said trigger event is a medical provider inquiry.  
     
     
         3 . The method of  claim 2  wherein said provided pertinent portions are based upon the nature of said inquiry.  
     
     
         4 . The method of  claim 3  wherein said pertinent portions are contained in a message sent over the Internet.  
     
     
         5 . The method of  claim 1  wherein said trigger event is activation of a rule.  
     
     
         6 . The method of  claim 5  wherein said provided pertinent portions are based upon the nature of said rule activation.  
     
     
         7 . The method of  claim 6  wherein said pertinent portions are contained in a message transmitted over the Internet.  
     
     
         8 . The method of  claim 1  wherein said provided portion is a holistic view of said patient's medical condition.  
     
     
         9 . The method of  claim 8  wherein said portion is tailored to what is required at the time said pertinent portion is provided.  
     
     
         10 . The method of  claim 1  wherein said trigger event is activation of a rule, said rule established by at least one of the following: a health care provider, a system administrator, a patient.  
     
     
         11 . The method of  claim 10  wherein limits for at least some of said rules are established on a patient-by-patient basis by a health care provider.  
     
     
         12 . The method of  claim 10  wherein limits for a group of patients are established for a group of patients by said system administrator.  
     
     
         13 . The method of  claim 10  further comprising establishing rules for patients based on group parameters.  
     
     
         14 . The method of  claim 13  further comprising: 
 setting limits on a patient-by-patient basis for at least some of said group parameter rules.    
     
     
         15 . The method of  claim 10  further comprising: 
 sending a message to a patient upon activation of a rule pertaining to said patient.    
     
     
         16 . The method of  claim 1  further comprising: 
 storing, in association with said abstracted information, data arriving from individual patients, said data pertaining to testing results obtained by said patient.    
     
     
         17 . A system for providing medical profiles to a patient, said system comprising: 
 means for obtaining data necessary to process payment to medical providers for a particular patient;    means for abstracting certain data from said obtained payment data;    means for creating a medical profile for a patient based upon said abstracted certain data; and    means based on a triggering event for sending at least said created medical profile to at least one of said patient's medical providers.    
     
     
         18 . The system of  claim 17  wherein said triggering event is rules-based.  
     
     
         19 . The system of  claim 18  further comprising: 
 means for allowing a patient's provider to establish certain of said rules for said patient.    
     
     
         20 . The system of  claim 18  further comprising: 
 means for allowing a patient to self-establish certain of said rules.    
     
     
         21 . The system of  claim 18  further comprising: 
 means for allowing a party other than said patient and said patient's medical provider to set rules for a defined group of patients.    
     
     
         22 . The system of  claim 18  further comprising: 
 means for sending a medical alert to a medical provider when a rule has been triggered.    
     
     
         23 . The system of  claim 18  further comprising: 
 means for sending a medical alert to said patient when a rule has been triggered    
     
     
         24 . A system for providing medical profiles to a patient, said system comprising: 
 means for obtaining data necessary to process payment to a medical provider for a particular patient;    means for abstracting certain data from said obtained data;    means for creating a medical profile on a patient based upon said abstracted certain data; and    means based on a triggering event and on said created medical profile for sending an alert that a certain medical condition is outside a defined limit.    
     
     
         26 . The system of claim  25  wherein said alert is sent to said patient.  
     
     
         26 . The system of claim  25  wherein said alert is sent to said patient's provider(s).  
     
     
         27 . The system of claim  25  further comprising: 
 means for establishing defined limits on a patient-by-patient basis.    
     
     
         28 . A medical alerting system comprising: 
 a database for storing medical data on a patient-by-patient basis, said medical data pertaining to provider diagnosis, provider visits, patient prescriptions and patient lab results;    a rules engine for reviewing data stored in said database, on a patient-by-patient basis; and    a notification system for sending medical alerts under control of said rules engine when data pertaining to a particular patient falls within a rule defined for said particular patient.    
     
     
         29 . The system of  claim 28  further comprising: 
 an adaptor for populating said database based upon data sent to a payor for reimbursement purposes.    
     
     
         30 . The system of  claim 28  further comprising: 
 a communication device for sending a medical alert to a provider when a rule has been triggered.    
     
     
         31 . The system of  claim 28  further comprising: 
 a communication device for sending a medical alert to said patient when a rule has been triggered.    
     
     
         32 . The system of  claim 28  wherein said notification system is responsive to an inquiry from an authorized provider for sending at least one medical profile to said provider, said profile tailored to the needs of said requesting provider.  
     
     
         33 . The system of  claim 32  wherein said obtaining means comprises: 
 means for obtaining data from patient, said data pertaining to medical conditions of said patient.    
     
     
         34 . The system of  claim 28  wherein said notification system is operable for sending alerts under control of said rules engine when certain expected data is missing.  
     
     
         35 . A method for providing medical alerting, said method comprising: 
 storing medical data on a patient-by-patient basis, said medical data pertaining to at least one of provider diagnosis, provider visits, patient prescriptions, patient lab results;    receiving from patients data pertaining to medical conditions pertaining to said patients;    reviewing stored data on a patient-by-patient basis, said review matching data received from a patient against stored data pertaining to said patient; and    said review results in information falling within at least one defined rule.    
     
     
         36 . The method of  claim 35  further comprising: 
 populating said database based upon data sent to a payor for reimbursement purposes.    
     
     
         37 . The method of  claim 35  further comprising: 
 sending a medical alert to a provider when said rule has been triggered.    
     
     
         38 . The method of  claim 35  further comprising: 
 sending a medical alert to said patient when said rule has been triggered.    
     
     
         39 . The method of  claim 35  wherein said rule is established for a plurality of patients on a non-specific patient basis.  
     
     
         40 . The method of  claim 35  wherein said rule is established specifically for certain of said patients.